Abstract title
Relationship of adiposity indices with cardio-metabolic and inflammatory markers among urban and rural adolescents
Co-authors	
M. Chopra1, A. Siddhu1, D. Bharadwaj2, N. Tandon3.
1Lady Irwin College, Food and Nutrition, New Delhi, India.
2Jawaharlal Nehru University, Systems Genomics Laboratory- School of Biotechnology, New Delhi, India.
3All India Institute of Medical Sciences, Endocrinology and Metabolism, New Delhi, India.
Abstract body	
Background
Obesity is associated with metabolic derangements and subclinical inflammation, with south Asians, specifically Indians, being vulnerable to chronic diseases potentially due to higher body fat content at lower BMI levels. Furthermore, adolescents as a group are especially vulnerable to develop obesity and associated co-morbidities.

Aim
To assess the levels of adiposity indices, cardio-metabolic risk factors and markers of inflammation among apparently healthy urban and rural Indian adolescents and determine relationship of adiposity indices with elevated levels of cardio-metabolic and inflammatory markers.

Method
Using a cross-sectional study design, a total of 2484 adolescents (11-17years) were recruited from schools in both urban (n=1790; 9 schools; Delhi) and rural areas (n=694; 3 schools; Harsaru village, District Gurgaon, Haryana and Duhai village, District Ghaziabad, Uttar Pradesh) of north India, by setting up health camps. Measurements of anthropometry, body composition and BP were done. Fasting blood samples were obtained and analysed for glucose, total cholesterol (TC), LDL-c, HDL-c, triglyceride (TG) and markers of inflammation (CRP, TNF-alpha, IL-6, leptin, resistin and adiponectin). Adiposity indices including BMI, waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), fat % and fat mass were divided into tertiles ( tertile 3 - high risk; tertile 1 - reference group). Logistic regression was used to estimate the odds ratio (OR) of individual elevated cardio-metabolic risk factors (systolic BP/diastolic BP≥95th percentile for height, age, gender; TC≥200mg/dL; LDL-c≥130mg/dL; HDL-c<40mg/dL; TG≥130mg/dL; fasting glucose≥126mg/dL) and markers of inflammation (higher than median value; CRP>0.4mg/L; TNF-alpha>31.2pg/mL; IL-6>3.5pg/mL; leptin>2.6ng/mL; resistin>7.4ng/mL; lower than median value, adiponectin<2625.5pg/mL) with adiposity indices (tertiles), adjusting for age, gender and location.

Results
Significantly higher median values of adiposity indices, systolic and diastolic BP, TC, LDL-c, CRP, TNF-alpha, leptin and lower levels of fasting glucose and adiponectin were observed among urban as compared to rural adolescents (p-values<0.001-0.019). Table 1 shows adjusted OR for elevated cardio-metabolic and inflammatory markers by adiposity indices (tertiles). Significant increase in OR at tertile 3 as compared to tertile 1 were observed for BP with WHR, WHtR; TC with WC; LDL-c with fat%; low HDL with WC, WHR; TG with BMI, WC; glucose with WC, WHR. Furthermore with inflammatory markers, significant increase in OR at tertile 3 was observed for CRP with BMI, WC, fat mass; TNF-alpha with WC, WHtR; IL-6 with WC; leptin with BMI, WC, fat mass; resistin with WC; low adiponectin with WHR.

Table 1: Logistic regression analyses of elevated cardio-metabolic and inflammatory markers with adiposity indices (tertiles)


High BP	High TC	High LDL-c	Low HDL-c	High TG	High fasting glucose	High CRP	High TNF-alpha	High IL-6	High leptin	High resistin	Low adiponectin
BMI	0.95 (0.52,1.74)	0.70 (0.17,2.81)	1.49 (0.35,6.38)	1.22 (0.70,2.12)	2.24* (1.08,4.62)	0.56 (0.16,1.98)	2.00** (1.24,3.23)	0.45 (0.15,1.33)	1.56 (0.65,3.73)	1.26* (1.02,2.14)	0.76 (0.33,1.75)	1.65 (0.71,3.81)
WC	0.92 (0.58,1.45)	2.53* (1.01,7.06)	1.72 (0.60,4.95)	1.42* (1.02,2.14)	1.49* (1.01,2.57)	3.35* (1.24,9.03)	2.21** (1.55,3.14)	3.12** (1.36,7.16)	1.57* (1.04,2.56)	3.45** (1.77,6.70)	1.67* (1.06,2.61)	0.35** (0.18,0.67)
Fat%	1.05 (0.63,1.73)	3.03 (0.93,9.84)	5.24** (1.54,17.8)	1.01 (0.63,1.61)	1.43 (0.78,2.64)	1.11 (0.30,4.17)	0.98 (0.65,1.49)	0.64 (0.25,1.63)	0.44* (0.20,0.97)	1.43 (0.65,3.15)	0.85 (0.41,1.75)	1.13 (0.56,2.27)
Fat mass	1.40 (0.79,2.47)	2.01 (0.52,7.75)	1.40 (0.36,5.40)	0.98 (0.571.66)	1.40 (0.69,2.84)	1.17 (0.30,4.5)	1.43* (1.02,2.37)	0.24** (0.08,0.69)	1.08 (0.46,2.54)	1.65* (1.04,4.26)	1.32 (0.60,2.94)	1.49 (0.67,3.31)
WHR	1.59* (1.03,2.71)	1.80 (0.60,5.46)	1.41 (0.44,4.53)	1.49* (1.04,2.36)	1.62 (0.89,2.93)	2.69* (1.11,7.56)	0.71 (0.47,1.06)	0.39* (0.16,0.98)	0.39* (0.18,0.83)	0.24** (0.12,0.49)	0.37** (0.18,0.78)	3.17** (1.45,6.90)
WHtR	2.63* (1.24,5.57)	0.37 (0.07,1.86)	0.30 (0.06,1.62)	1.21 (0.62,2.35)	0.46* (0.19,0.98)	0.85 (0.20,3.61)	1.40 (0.79,2.48)	3.79*(1.02.15.24)	1.34 (0.45,3.98)	2.24 (0.82,6.26)	2.18 (0.77,6.17)	0.54 (0.18,1.61)
Values are OR (95% Class Interval) for tertile 3 as compared to tertile 1 (reference) for adiposity indices. 
Adjusted for age, gender and location. 
**p<0.01;*p<0.05. 
Tertiles: BMI (tertile1,<16.6kg/m2; tertile2,16.6-19.4kg/m2; tertile3,>19.4kg/m2); WC (tertile1,<64.0cm; tertile2,64.0-73.5cm; tertile3,>73.5cm); WHR (tertile1,<0.50; tertile2,0.50-0.56; tertile3,>0.56); WHtR (tertile1,<0.26; tertile2,0.26-0.30; tertile3,>0.30); fat% (tertile1,<11.9%; tertile2,11.9-20.2%; tertile3,>20.2%); FM (tertile1,<4.9 kg; tertile2,4.9-9.7 kg; tertile3,>9.7 kg).
Discussion
Significantly higher levels of adiposity indices, body composition, cardio-metabolic and inflammatory markers were obtained among urban as compared to rural adolescents. For most of the adiposity indices, an increase in odds at tertile 3 was observed as compared to tertile 1 with cardio-metabolic and inflammatory markers, highlighting the relationship between adiposity and cardio-metabolic risk, even among adolescents.

Conflict of Interest
I have no potential conflict of interest to disclose